Treatments for Flaviviridae virus infection

ABSTRACT

The present invention provides methods for treating infections, in a host, by viruses belonging to the Flaviviridae family, such as HCV, comprising administering an Ara-C homologue to the host.

This application is a continuation of U.S. patent application Ser. No.11/365,008, filed Mar. 1, 2006, now U.S. Pat. No. 7,524,831; whichclaims the benefit of U.S. provisional patent application No.60/658,006, filed Mar. 2, 2005; each of which is herein incorporated byreference in its entirety.

FIELD OF THE INVENTION

The present invention comprises methods for treating or preventing aviral infection in subject.

BACKGROUND OF THE INVENTION

Viruses belonging to the Flaviviridae family include the hepatitis Cvirus (HCV). The Flavivirus genus includes more than 68 membersseparated into groups on the basis of serological relatedness. Clinicalsymptoms vary and include fever, encephalitis and hemorrhagic fever.Flaviviruses of global concern that are associated with human diseaseinclude the dengue hemorrhagic fever viruses (DHF), yellow fever virus,shock syndrome and Japanese encephalitis virus.

Examples of antiviral agents that have been identified as active againstthe flavivirus or pestiviruses include:

-   (1) Interferon and ribavirin;-   (2) Substrate-based NS3 protease inhibitors (WO 98/22496);-   (3) Non-substrate-based inhibitors such as    2,4,6-trihydroxy-3-nitro-benzamide derivatives (Sudo K. et al.,    Biochemical and Biophysical Research Communications, 238:643-647    (1997); Sudo K., et al. Antiviral Chemistry and Chemotherapy, 9:186    (1998)), including RD3-4082 and RD3-4078, the former substituted on    the amide with a 14 carbon chain and the latter processing a    para-phenoxyphenyl group;-   (4) Thiazolidine derivatives, which show relevant inhibition in a    reverse-phase HPLC assay with an NS3/4A fusion protein and NS5A/5B    substrate (Sudo K. et al., Antiviral Research, 32: 9-18 (1996)),    especially compound RD-1-6250, possessing a fused cinnamoyl moiety    substituted with a long alkyl chain, RD4 6205 and RD4 6193;-   (5) Thiazolidines and benzanilides, identified in Kakiuchi N. et    al. J. FEBS Letters 421, 217-220; and Takeshita N. et al. Analytical    Biochemistry, 247: 242-246 (1997);-   (6) A phenanthrenequinone, which possesses activity against protease    in a SDS-PAGE and autoradiography assay and is isolated from the    fermentation culture broth of Streptomyces sp., Sch 68631 (Chu M. et    al., Tetrahedron Letters, 37: 7229-7232 (1996)), and Sch 351633,    isolated from the fungus Penicillium griscofuluum, which    demonstrates activity in a scintillation proximity assay;-   (7) Selective NS3 inhibitors based on the macromolecule elgin c,    isolated from leech (Qasim M. A. et al., Biochemistry, 36: 1598-1607    (1997));-   (8) Helicase inhibitors (U.S. Pat. No. 5,633,358);-   (9) Polymerase inhibitors, such as nucleotide analogues, gliotoxin    (Ferrari E. et al., Journal of Virology, 73:1649-1654 (1999)), and    the natural product cerulenin (Lohmann V. et al., Virology, 249:    108-118 (1998));-   (10) Antisense phosphorothioate oligodeoxynucleotides (S-ODN)    complementary to sequence stretches in the 5′ non-coding region    (NCR) of the virus, or nucleotides 326-348 comprising the 3′ end of    the NCR and nucleotides 371-388 located in the core coding region of    the HCV RNA;-   (11) Inhibitors of IRES-dependent translation;-   (12) Nuclease-resistant ribozymes; and-   (13) Miscellaneous compounds including 1-amino-alkyloyclohexanes    (U.S. Pat. No. 6,034,134 to Gold et al.), alkyl lipids (U.S. Pat.    No. 5,922,757 to Chojkier et al.), vitamin E and other antioxidants    (U.S. Pat. No. 5,922,757 to Chojkier et al.), squalene, amantadine,    bile acids (U.S. Pat. No. 5,846,964 to Ozeki et al.),    N-(phosphonoacetyl)-L-aspartic acid, (U.S. Pat. No. 5,830,905 to    Diana et al.), benzenedicarboxamides (U.S. Pat. No. 5,633,388 to    Diana et al.), polyadenylic acid derivatives (U.S. Pat. No.    5,496,546 to Wang et al.), 2′,3′ dideoxyinosine (U.S. Pat. No.    5,026,687 to Yarchoan et al.), and benzimidazoles (U.S. Pat. No.    5,891,874 to Colacino et al.).

Although there are several treatments available for flaviviralinfections, some flaviviral infections fail to respond adequately tocurrently available treatments. Hence, there is a need to provideadditional, effective methods for treating and/or preventing such aninfection comprising administration of various analogues of Ara-C.

Ara-C

an arabinofuranosylcytosine nucleoside analogue, and prodrug analoguesof Ara-C, including fosteabine(1-β-D-arabinofuranosylcytosine-5′-stearylphosphate; YNK01), have beenused effectively to treat acute myelogenous leukemia and lymphocyticleukemias (Gahrton et al., Adv. Cancer Res. 40:255-329 (1983); Keatinget al., JAMA 248:2481-2486 (1982); Plunkett et al., Semin. Oncol.20:50-63 (1993); Maloisel, et al., Leukemia 16(4): 573-80 (2002); Kuhret al., Leuk. Res. 24(7): 583-587 (2000); Inaba et al., Gan To KagakuRyoho. 21(4): 535-538 (1994)).

Moreover, Ara-C homologues, including N⁴-(dialkylamino)methylenederivatives of 2′-dC have been shown in the past to be effective in thetreatment of infections from retroviruses, including HIV (see e.g., Kerret al., J. Med. Chem. 35:1996-2001 (1992); Kerr et al., J. Pharm Sci.83(4): 582-586 and U.S. Pat. Nos. 5,051,498 and 5,886,162).

This invention addresses the need to identify additional, effectivemethods for treating or preventing Flaviviridae infections by providingmethods using ara-C analogue compounds for the effective treatment orprevention of Flaviviridae virus (e.g., hepatitis C virus) infections.

SUMMARY OF THE INVENTION

The present invention provides a method for (i) treating a host infectedwith a virus which is a member of the Flaviviridae family of viruses(e.g., hepatitis C virus) or for (ii) preventing infection of a host,with a virus which is a member of the Flaviviridae family of viruses(e.g., hepatitis C virus), for example, following, transplantation of aliver into said host or transfusion of blood into said host, whichcomprises administering to said host a therapeutically effective amountof a compound of formula I:

or a pharmaceutically acceptable salt thereof; wherein R^(2′) and R^(3′)are independently —OH or a pharmaceutically acceptable leaving groupwhich is capable of being converted into —OH, F or —CH₃ when thecompound represented by formula I is administered in vivo, and R^(5′) isa straight or branched chain C₉ to C₂₄ alkylphosphate or a straight orbranched chain C₉ to C₂₄ alkenylphosphate group or a pharmaceuticallyacceptable leaving group which is capable of being converted into —OH orphosphate when the compound represented by formula I is administered invivo.

In an embodiment of the invention, the compound represented bystructural formula I is administered to a host in association with anyother anti-viral agent as set forth in the “Pharmaceutical Compositions”section below, for example, an interferon-alfa or a pegylatedinterferon-alfa; including, but not limited to interferon alfa-2a,interferon alfa-2b, interferon alfa-2c, interferon alfa n-1, interferonalfa n-3, consensus interferon, pegylated interferon alfa-2a, pegylatedinterferon alfa-2b, pegylated interferon alfa-2c, pegylated interferonalfa n-1, pegylated interferon alfa n-3, pegylated consensus interferonor albumin-interferon-alpha.

In an embodiment, a compound comprising structural formula I isadministered to the host in association with ribavirin and/or apegylated or unpegylated interferon.

Triple combination therapies are also within the scope of the inventionwherein a compound represented by structural formula I is administeredto a host in association with ribavirin and one or more of theinterferons (pegylated or unpegylated) mentioned herein (e.g., pegylatedor unpegylated interferon alfa-2a or pegylated or unpegylated interferonalfa-2b).

In an embodiment of the invention, in a compound comprising structuralformula I, R^(2′)═R^(3′)═-OH; R^(5′) is a C₁₆ to C₂₀ alkylphosphategroup; R^(5′) is a C₁₈ to C₂₀ alkylphosphate group; R^(5′) is a C₁₈ toC₂₀ alkenylphosphate group; or R^(5′) is —OPO₃H—C₁₈H₃₇.

The present invention also provides a method for (i) treating a hosthaving hepatitis C virus infection (e.g., chronic infection or acuteinfection) or for (ii) preventing infection of a host, with hepatitis Cvirus, for example, following transplantation of a liver into said hostor transfusion of blood into said host that comprises administering, tothe host, a therapeutically effective amount of a compound representedby structural formula II:

or a pharmaceutically acceptable salt thereof;in association with a therapeutically effective amount of an interferonfor a treatment time period sufficient to eradicate detectable hepatiticC virus-RNA and to maintain no detectable hepatitic C virus —RNA for atleast twelve weeks after the end of the treatment time period;wherein R^(2′) and R^(3′) are independently —OH or a pharmaceuticallyacceptable leaving group which is capable of being converted to —OH, For —CH₃ when the compound represented by formula II is administered invivo.

In an embodiment of the invention, a compound represented by structuralformula II is administered to a host in association with any otheranti-viral agent as set forth in the “Pharmaceutical Compositions”section below, for example, pegylated or unpegylated interferon alfa,e.g. selected from the group consisting of pegylated interferon alfa-2a,pegylated interferon alfa-2b, pegylated interferon alfa-2c, pegylatedinterferon alfa n-1, pegylated interferon alfa n-3, pegylated consensusinterferon, interferon alfa-2a, interferon alfa-2b, interferon alfa-2c,interferon alfa n-1, interferon alfa n-3, consensus interferon andalbumin-interferon-alpha.

In another embodiment of the invention a compound represented bystructural formula II is administered to a host in association withribavirin and/or a pegylated or unpegylated interferon.

Triple combination therapies are also within the scope of the inventionwherein a compound represented by structural formula II is administeredto a host in association with ribavirin and one or more of theinterferons (pegylated or unpegylated) mentioned herein (e.g., pegylatedor unpegylated interferon alfa-2a or pegylated or unpegylated interferonalfa-2b).

A further embodiment of the invention comprises administering a compoundcomprising structural formula II to a host wherein, in structuralformula II, R^(2′)═R^(3′)═—OH.

Yet another embodiment of the invention comprises methods wherein thehost who is administered a compound comprising a structural formula IIis infected with multiple hepatitis C virus genotypes (e.g., genotype 1and/or genotype 2 and/or genotype 3).

The present invention provides a method for (i) treating a host havinghepatitis C virus infection (e.g., chronic infection or acute infection)or for (ii) preventing infection of a host, with hepatitis C virus, forexample, following transplantation of a liver into said host ortransfusion of blood into said host that comprises administering to thepatient a therapeutically effective amount of a compound represented bystructural formula III (fosteabine;1-β-D-arabinofuranosylcytosine-5′-stearylphosphate; YNK01):

or a pharmaceutically acceptable salt thereof; optionally in associationwith a therapeutically effective amount of any other anti-viral agent asset forth in the “Pharmaceutical Compositions” section below, forexample, unpegylated or pegylated interferon alfa (e.g., unpegylated orpegylated interferon alfa-2a, unpegylated or pegylated interferonalfa-2b, unpegylated or pegylated interferon alfa-2c, unpegylated orpegylated interferon alfa n-1, unpegylated or pegylated interferon alfan-3 or unpegylated or pegylated consensus interferon) for a treatmenttime period sufficient to eradicate detectable hepatitis C virus-RNA andto maintain no detectable hepatitis C virus-RNA for at least twelveweeks after the end of the treatment time period.

In one embodiment of the present invention, the pegylated interferonalfa that is administered to the host in association with a compoundrepresented by structural formula III is a pegylated interferon alfa-2bwherein the amount of pegylated interferon alfa-2b that is administeredin the treatment time period is about 0.5 to 1.5 micrograms per kilogrambody weight of pegylated interferon alfa-2b protein per week on a weeklybasis for at least twenty-four weeks.

In another embodiment of the invention, pegylated interferon alfa thatis administered in association with compound represented by structuralformula III is a pegylated interferon alfa-2b, wherein the pegylatedinterferon alfa-2b is administered on a weekly basis for aboutforty-eight weeks.

Triple combination therapies are also within the scope of the inventionwherein a compound represented by structural formula III is administeredto a host in association with ribavirin and one or more of theinterferons (pegylated or unpegylated) mentioned herein (e.g., pegylatedor unpegylated interferon alfa-2a or pegylated or unpegylated interferonalfa-2b).

The present invention provides a method for treating a host infectedwith a virus which is a member of the Flaviviridae family of viruses(e.g., hepatitis C virus) or for preventing the infection, comprisingadministering to said host a therapeutically effective amount of acompound represented by formula IV

or a pharmaceutically acceptable salt thereof; wherein R³ and R⁴ areindependently —OH or a pharmaceutically acceptable leaving group whichis capable of being converted to phosphate, —OH, F or —CH₃ when thecompound represented by formula IV is administered in vivo, wherein R⁵is —OH, a straight or branched chain C₉ to C₂₄ alkylphosphate (e.g.,—OPO₃—C₁₈H₃₇) or a straight or branched chain C₉ to C₂₄ alkenylphosphategroup or a pharmaceutically acceptable leaving group which is capable ofbeing converted into —OH, phosphate, F or —CH₃ when the compoundrepresented by formula IV is administered in vivo; and wherein R¹ and R²are independently C₁ to C₁₀ alkyl or wherein R¹ and R² taken togetherwith N form a C₃ to C₇ ring represented by the following structuralformula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

In an embodiment of the invention, the compound represented bystructural formula IV is administered in association withinterferon-alfa, pegylated interferon-alfa or albumin-interferon-alpha,an interferon-alfa selected from the group consisting of interferonalfa-2a, interferon alfa-2b, interferon alfa-2c, interferon alfa n-1,interferon alfa n-3 and consensus interferon, a pegylatedinterferon-alfa selected from the group consisting of pegylatedinterferon alfa-2a, pegylated interferon alfa-2b, pegylated interferonalfa-2c, pegylated interferon alfa n-1, pegylated interferon alfa n-3,or pegylated consensus interferon or any combination thereof.

In an embodiment of the invention, the compound represented by formulaIV is further administered in association with ribavirin.

In an embodiment of the invention, in the compound of structural formulaIV, R³═R⁴═R⁵═—OH; R¹ and R² are C₁-C₅ alkyl; R¹ and R² are isopropyl; R¹and R² taken together with N are represented by the structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl; orR¹ and R² taken together with N are represented by the followingstructural formula:

The present invention provides a method for treating a host having ahepatitis C virus infection or for preventing the infection thatcomprises administering, to the host, a therapeutically effective amountof a compound represented by structural formula V:

or a pharmaceutically acceptable salt thereof;in association with a therapeutically effective amount of an interferonfor a treatment time period sufficient to eradicate detectable hepatiticC virus-RNA and to maintain no detectable hepatitic C virus RNA for atleast twelve weeks after the end of the treatment time period;wherein R⁵ is —OH, a straight or branched chain C₉ to C₂₄ alkylphosphate(e.g., —OPO₃—C₁₈H₃₇) or a straight or branched chain C₉ to C₂₄alkenylphosphate group or a pharmaceutically acceptable leaving groupwhich is capable of being converted into —OH, phosphate, F or —CH₃ whenthe compound represented by formula V is administered in vivo, andwherein R¹ and R² are independently C₁ to C₁₀ alkyl or wherein R¹ and R²taken together with N form a C₃ to C₇ ring represented by the followingstructural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

In an embodiment of the invention, the interferon that is administeredis pegylated interferon alfa and is selected from the group consistingof pegylated interferon alfa-2a, pegylated interferon alfa-2b, pegylatedinterferon alfa-2c, pegylated interferon alfa n-1, pegylated interferonalfa n-3, pegylated consensus interferon, interferon alfa-2a, interferonalfa-2b, interferon alfa-2c, interferon alfa n-1, interferon alfa n-3and consensus interferon.

In an embodiment of the invention, the compound represented by formula Vis administered in association with ribavirin. In an embodiment of theinvention, R⁵═—OH.7

In an embodiment of the invention, the host is infected with multiplehepatitis C virus genotypes (e.g., hepatitis C virus genotype 1 and/orhepatitis C virus genotype 2 and/or hepatitis C virus genotype 3).

The present invention provides a method for treating a host having ahepatitis C virus infection or for preventing the infection thatcomprises administering to the host a therapeutically effective amountof a compound represented by a structural formula selected from thegroup consisting of:

or a pharmaceutically acceptable salt thereof.

In an embodiment of the invention, a compound selected from structuralformulas VI-XXIII is administered to the host in association with anyother anti-viral agent as set forth in the “Pharmaceutical Compositions”section below, for example, one or more members selected from the groupconsisting of pegylated interferon alfa-2a, pegylated interferonalfa-2b, pegylated interferon alfa-2c, pegylated interferon alfa n-1,pegylated interferon alfa n-3, pegylated consensus interferon,interferon alfa-2a, interferon alfa-2b, interferon alfa-2c, interferonalfa n-1, interferon alfa n-3 and consensus interferon.

In an embodiment of the invention, a compound selected from structuralformulas VI-XXIII is administered to the host in association ribavirin.

The present invention provides a method for preventing infection of ahost, with a virus which is a member of the Flaviviridae family ofviruses (e.g., hepatitis C virus), following transplantation of a liverinto said host or transfusion of blood into said host or for treatingthe infection in the host comprising administering to said host atherapeutically effective amount of a compound represented by structuralformula IV:

or a pharmaceutically acceptable salt thereof; wherein R³ and R⁴ areindependently —OH or a pharmaceutically acceptable leaving group whichis capable of being converted to phosphate, —OH, F or —CH₃ when thecompound represented by formula IV is administered in vivo, wherein R⁵is —OH, a straight or branched chain C₉ to C₂₄ alkylphosphate (e.g.,—OPO₃—C₁₈H₃₇) or a straight or branched chain C₉ to C₂₄ alkenylphosphategroup or a pharmaceutically acceptable leaving group which is capable ofbeing converted into —OH, phosphate, F or —CH₃ when the compoundrepresented by formula IV is administered in vivo and wherein R¹ and R²are independently C₁ to C₁₀ alkyl or wherein R¹ and R² taken togetherwith N form a C₃ to C₇ ring represented by the following structuralformula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

In an embodiment of the invention, the compound represented by formulaIV is administered in association with any other anti-viral agent as setforth in the “Pharmaceutical Compositions” section below, for example,interferon-alfa, pegylated interferon-alfa, albumin-interferon-alpha,interferon alfa-2a, interferon alfa-2b, interferon alfa-2c, interferonalfa n-1, interferon alfa n-3, consensus interferon, pegylatedinterferon alfa-2a, pegylated interferon alfa-2b, pegylated interferonalfa-2c, pegylated interferon alfa n-1, pegylated interferon alfa n-3,or pegylated consensus interferon.

In an embodiment of the invention, the compound represented by formulaIV is administered in association with ribavirin.

In an embodiment of the invention, in the compound represented byformula IV: R³═R⁴═—OH; R³═R⁴═R⁵═—OH; R¹ and R² are C₁-C₅ alkyl; R¹ andR² are isopropyl; R¹ and R² taken together with N are represented by thestructural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl; orR¹ and R² taken together with N are represented by the followingstructural formula:

The present invention provides a composition represented by formula IV

-   -   IV        or a pharmaceutically acceptable salt thereof; wherein R³ and R⁴        are independently —OH or a pharmaceutically acceptable leaving        group which is capable of being converted to phosphate, —OH, —F        or —CH₃ when the compound represented by formula IV is        administered in vivo, wherein R⁵ is —OH, a straight or branched        chain C₉ to C₂₄ alkylphosphate or a straight or branched chain        C₉ to C₂₄ alkenylphosphate group or a pharmaceutically        acceptable leaving group which is capable of being converted        into —OH, phosphate, F or —CH₃ when the compound represented by        formula IV is administered in vivo and wherein R¹ and R² are        independently C₁ to C₁₀ alkyl or wherein R¹ and R² taken        together with N form a C₃ to C₇ ring represented by the        following structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

optionally in association with any other anti-viral agent as set forthin the “Pharmaceutical Compositions” section below, for example, one ormore members selected from the group consisting of pegylated interferonalfa-2a, pegylated interferon alfa-2b, pegylated interferon alfa-2c,pegylated interferon alfa n-1, pegylated interferon alfa n-3, pegylatedconsensus interferon, interferon alfa-2a, interferon alfa-2b, interferonalfa-2c, interferon alfa n-1, interferon alfa n-3 and consensusinterferon. In an embodiment of the invention, the compound isrepresented by a structural formula selected from the group consistingof:

The present invention also provides a compound of formula I:

or a pharmaceutically acceptable salt thereof; wherein R^(2′) and R^(3′)are independently —OH or a pharmaceutically acceptable leaving groupwhich is capable of being converted into —OH, F or —CH₃ when thecompound represented by formula I is administered in vivo, and R^(5′) isa straight or branched chain C₉ to C₂₄ alkylphosphate or a straight orbranched chain C₉ to C₂₄ alkenylphosphate group or a pharmaceuticallyacceptable leaving group which is capable of being converted into —OH orphosphate when the compound represented by formula I is administered invivo; in association with any other anti-viral agent as set forth in the“Pharmaceutical Compositions” section below, for example, one or moremembers selected from the group consisting of pegylated interferonalfa-2a, pegylated interferon alfa-2b, pegylated interferon alfa-2c,pegylated interferon alfa n-1, pegylated interferon alfa n-3, pegylatedconsensus interferon, interferon alfa-2a, interferon alfa-2b, interferonalfa-2c, interferon alfa n-1, interferon alfa n-3 and consensusinterferon. In an embodiment, the compound represented by structuralformula I is represented by the following structural formula:

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides compositions and methods for treating orpreventing an infection by a virus which is a member of the Flaviviridaefamily in a host. For example, the present invention includes, but isnot limited to methods for treating or preventing infections caused bymembers of the Hepacivirus genus which includes the hepatitis C virus(HCV). HCV includes several types, subtypes and isolates:

hepatitis C virus (isolate 1)

hepatitis C virus (isolate BK)

hepatitis C virus (isolate EC1)

hepatitis C virus (isolate EC10)

hepatitis C virus (isolate HC-J2)

hepatitis C virus (isolate HC-J5)

hepatitis C virus (isolate HC-J6)

hepatitis C virus (isolate HC-J7)

hepatitis C virus (isolate HC-J8)

hepatitis C virus (isolate HC-JT)

hepatitis C virus (isolate HCT18)

hepatitis C virus (isolate HCT27)

hepatitis C virus (isolate HCV-476)

hepatitis C virus (isolate HCV-KF)

hepatitis C virus (isolate Hunan)

hepatitis C virus (isolate Japanese)

hepatitis C virus (isolate Taiwan)

hepatitis C virus (isolate TH)

hepatitis C virus isolate H

hepatitis C virus type 1

-   -   hepatitis C virus type 1a        -   hepatitis C virus strain H77    -   hepatitis C virus type 1b    -   hepatitis C virus type 1c    -   hepatitis C virus type 1d    -   hepatitis C virus type 1e    -   hepatitis C virus type 1f

hepatitis C virus type 10

hepatitis C virus type 2

-   -   hepatitis C virus type 2a    -   hepatitis C virus type 2b    -   hepatitis C virus type 2c    -   hepatitis C virus type 2d    -   hepatitis C virus type 2f

hepatitis C virus type 3

-   -   hepatitis C virus type 3a    -   hepatitis C virus type 3b    -   hepatitis C virus type 3g

hepatitis C virus type 4

-   -   hepatitis C virus type 4a    -   hepatitis C virus type 4c    -   hepatitis C virus type 4d    -   hepatitis C virus type 4f    -   hepatitis C virus type 4h    -   hepatitis C virus type 4k

hepatitis C virus type 5

-   -   hepatitis C virus type 5a

hepatitis C virus type 6

-   -   hepatitis C virus type 6a

hepatitis C virus type 7

-   -   hepatitis C virus type 7a    -   hepatitis C virus type 7b

hepatitis C virus type 8

-   -   hepatitis C virus type 8a

The present invention also includes methods for treating or preventinginfection caused by members of the Flavivirus genus. The Flavivirusgenus includes Yellow fever virus; Tick-borne viruses such as theGadgets Gully virus, Kadam virus, Kyasanur Forest disease virus, Langatvirus, Omsk hemorrhagic fever virus, Powassan virus, Royal Farm virus,Karshi virus, Tick-borne encephalitis virus, Neudoerfl virus, Sofjinvirus, Louping ill virus and the Negishi virus; seabird tick-borneviruses such as the Meaban virus, Saumarez Reef virus, and the Tyuleniyvirus; mosquito-borne viruses such as the Aroa virus, Bussuquara virus,Iguape virus and the Naranjal virus; Dengue viruses such as the Denguevirus and the Kedougou virus; Japanese encephalitis viruses such as theCacipacore virus, Koutango virus, Japanese encephalitis virus, MurrayValley encephalitis virus, Alfuy virus, St. Louis encephalitis virus,Usutu virus, West Nile virus, Kunjin virus and the Yaounde virus;Kokobera viruses such as the Kokobera virus and the Stratford virus;Ntaya viruses such as the Bagaza virus, Ilheus virus, Rocio virus,Israel turkey meningoencephalomyelitis virus, Ntaya virus and theTembusu virus; Spondweni viruses such as the Zika virus and theSpondweni virus; Yellow fever viruses such as the Banzi virus, Boubouivirus, Edge Hill virus, Jugra virus, Saboya virus, Potiskum virus, Sepikvirus, Uganda S virus, Wesselsbron virus and the Yellow fever virus;Entebbe viruses such as the Entebbe bat virus, Sokoluk virus, and theYokose virus; Modoc viruses such as the Apoi virus, Cowbone Ridge virus,Jutiapa virus, Modoc virus, Sal Vieja virus and the San Perlita virus;Rio Bravo viruses such as the Bukalasa bat virus, Carey Island virus,Dakar bat virus, Montana myotis leukoencephalitis virus, Phnom Penh batvirus, Batu Cave virus, Rio Bravo virus, Tamana bat virus, and the Cellfusing agent virus.

The present invention includes methods for treating or preventinginfection caused by members of the Pestivirus genus. The Pestivirusgenus includes, Border disease virus (sheep), Bovine viral diarrheavirus 1, Bovine viral diarrhea virus 2, Classical swine fever virus, andHog cholera virus.

Moreover, the present invention includes methods for treating orpreventing infections caused by Hepatitis G virus or Hepatitis GBvirus-A, B or C.

A “host”, “subject” or “patient” may be any organism, such as a mammal(e.g., primate, dog, cat, cow, horse, pig, goat, rat, mouse, bird),preferably a human.

A person suffering from chronic hepatitis C infection may exhibit one ormore of the following signs or symptoms:

(a) elevated ALT,

(b) positive test for anti-HCV antibodies,

(c) presence of HCV as demonstrated by a positive test for HCV-RNA,

(d) clinical stigmata of chronic liver disease,

(e) hepatocelluar damage.

A patient or host suffering from an infection by a Flaviviridae virus,such as HCV (e.g., a chronic or acute HCV infection), can be treated byadministering to the patient a compound represented by structuralformula I:

or a pharmaceutically acceptable salt thereof.

R^(2′) and R^(3′) are independently —OH or a pharmaceutically acceptableleaving group which is capable of being converted to phosphate, —OH, —For —CH₃ when the compound represented by formula I is administered invivo.

R^(5′) is a straight or branched chain C₉ to C₂₄ alkylphosphate (e.g.,Cg, C₁₀, C₁₁, C₁₂, C₁₃, C₁₄, C₁₅, C₁₆, C₁₇, C₁₈, C₁₉, C₂₀, C₂₁, C₂₂, C₂₃or C₂₄ alkylphosphate, including C₁₆ to C₂₀ alkylphosphate or C₁₈ to C₂₀alkylphosphate) or straight or branched chain C₉ to C₂₄ alkenylphosphate(e.g., C₉, C₁₀, C₁₁, C₁₂, C₁₃, C₁₄, C₁₅, C₁₆, C₁₇, C₁₈, C₁₉, C₂₀, C₂₁,C₂₂, C₂₃ or C₂₄ alkenylphosphate, including C₁₈ to C₂₀ alkenylphosphate)group or a pharmaceutically acceptable leaving group which is capable ofbeing converted to —OH or phosphate when the compound represented byformula I is administered in vivo.

For example, the compound can be represented by structural formula II:

The compound represented by structural formula II is also known asFosteabine and as YNK01. Fosteabine is an orally active derivative ofcytarabine which is sold by Nippon Kayaku Co. Ltd. (Tokyo, Japan).

Furthermore, a patient suffering from an infection by a flaviviridaevirus, such as HCV (e.g., a chronic HCV infection), can be treated byadministering to the patient a compound represented by structuralformula IV:

or a pharmaceutically acceptable salt thereof.

R³ and R⁴ are independently —OH or a pharmaceutically acceptable leavinggroup which is capable of being converted to —F, —CH₃—OH or phosphatewhen the compound represented by formula IV is administered in vivo,wherein R⁵ is —OH, a straight or branched chain C₉ to C₂₄ alkylphosphate(e.g., —OPO₃—C₁₈H₃₇ or as described above) or a straight or branchedchain C₉ to C₂₄ alkenylphosphate group (e.g., as described above) or apharmaceutically acceptable leaving group which is capable of beingconverted into —OH, phosphate, F or —CH₃ when the compound representedby formula IV is administered in vivo and wherein R¹ and R² areindependently C₁ to C₁₀ alkyl or R¹ and R² taken together with the Nform a C₃ to C₇ ring represented by the following structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, S, SOor SO₂ and R is independently H, C₁ to C₆ alkyl or acyl. Such compoundsare discussed for example, in Kerr et al., J. Pharm Sci. 83(4):582-586(1994).In an embodiment of the invention, a compound represented by structuralformula VI, VII, VIII, IX, X, XI, XII, XIII, XIV, XV, XVI, XVI, XVII,XVIII, XIX, XX, XXI, XXII or XXIII:

can be administered to a host suffering from a Flaviviridae (e.g., HCV)infection (e.g., chronic HCV infection).

A compound represented by a structural formula selected from I-XXIII canalso be administered to a patient in association with one or more otheranti-viral agents such as pegylated or unpegylated interferon alfa-2a,pegylated or unpegylated interferon alfa-2b, pegylated or unpegylatedinterferon alfa-2c, pegylated or unpegylated interferon alfa n-1,pegylated or unpegylated interferon alfa n-3 or pegylated or unpegylatedconsensus interferon.

“Phosphate” refers to —PO₃H₂ or any of its corresponding ions.

The term “alkyl” as used herein means straight and branched carbonchains of one to twenty four carbons (e.g., C₁, C₂, C₃, C₄, C₅, C₆, C₇,C₈, C₉, C₁₀, C₁₁, C₁₂, C₁₃, C₁₄, C₁₅, C₁₆, C₁₇, C₁₈, C₁₉, C₂₀, C₂₁, C₂₂,C₂₃ or C₂₄).

“Alkylphosphate” is —O—PO₃H-alkyl or any of its corresponding ions.

The term “alkenyl” or “alkene” as used herein means straight andbranched chain alkyl groups containing at least one carbon-carbon doublebond and two to twenty four carbons (e.g., C₂, C₃, C₄, C₅, C₆, C₇, C₈,C₉, C₁₀, C₁₁, C₁₂, C₁₃, C₁₄, C₁₅, C₁₆, C₁₇, C₁₈, C₁₉, C₂₀, C₂₁, C₂₂, C₂₃or C₂₄).

“Alkenylphosphate” is —O—PO₃H-alkene or any of its corresponding ions.

The term “aryl” represents a carbocyclic group (e.g., monocyclic ormulticyclic) containing from 6 to 15 carbon atoms and having at leastone aromatic ring (e.g., phenyl ring or naphthyl ring).

As used herein, the term “heteroaryl” refers to an aryl group having oneor more heteroatoms in the aromatic rings (e.g., N, O or S).

The term “arylalkyl” or “aralkyl” as used herein means an alkyl groupsubstituted by an aryl group.

The term “cycloalkyl” as used herein means carbocyclic rings of three totwelve carbons, preferably three to seven carbons and more preferablythree to six carbons optionally substituted by one or more double bonds.

“Acyl” means a radical of a carboxylic acid having the formula.alkyl-C(O)—, aryl-C(O)—, aralkyl-C(O)—, (C₃-C₇)cycloalkyl-C(O)—,(C₃-C₇)cycloalkyl-(C₁-C₆)alkyl-C(O)—, and heteroaryl-C(O)—, whereinalkyl, aralkyl and heteroaryl are as defined herein; aryl is phenyl ornaphthyl; and aralkyl is aryl-(C₁-C₆)alkyl, wherein aryl is as definedabove.

Methyl is —CH₃ Ethyl is —CH₂—CH₃ n-propyl is —CH₂CH₂CH₃. i-propyl is—CH—(CH₃)₂. n-butyl is —CH₂CH₂CH₂CH₃.

The term “pharmaceutically acceptable leaving group” refers to a leavinggroup which, when administered to a host in accordance with theinvention, is non-toxic and includes amino acids residues, carbohydrateresidues, peptide residues and cholesterol residues.

For example, an amino acid pharmaceutically acceptable leaving group canbe a natural or unnatural α-amino acid residue:

-   wherein Y═H, CH₃; CH₃CH₂—; CH₃CH₂CH₂—; Me₂CH—; Me₂CH₂CH₂—;    CH₃CH₂CH(Me)-PhCH₂—; HOOCCH₂CH₂—; HSCH₂—; HOOCCH₂—; MeSCH₂CH₂—;    HOCH₂—;

or Y is H₂N(CH₂)₄— or CH₃CH(OH)—; or a pharmaceutically acceptable saltthereof;or Y taken together with the α carbon and N form

or a pharmaceutically acceptable salt thereof. A pharmaceuticallyacceptable peptide residue leaving group can be, for example, acombination of two or more of the amino acids set forth above (e.g.,dipeptide or tripeptide). Furthermore, a pharmaceutically acceptablecarbohydrate residue leaving group can be, for example, a monosaccharidesuch as glucose

galactose

or a combination of two or more monosaccharides such as lactose

or sucrose

Synthesis of the compounds of the invention, comprising such leavinggroups can be done by any practitioner of ordinary skill in the art(see, for example, Protective Groups in Organic Synthesis, by TheodoraW. Greene, Peter G. M. Wuts; John Wiley & Sons, Inc. New York (1991)).

In a liver transplantation procedure, the donor liver can come from aliving donor (i.e., living donor liver transplantation (LDLT)) wherein aportion of the donor's liver is removed and introduced into therecipient. Alternatively, the transplant can be from a deceased donorwherein the entire liver is removed and transplanted.

The scope of the present invention also includes compounds representedby structural formula IV:

or a pharmaceutically acceptable salt thereof; wherein R³ and R⁴ areindependently —OH or a pharmaceutically acceptable leaving group whichis capable of being converted to phosphate, —OH, F or —CH₃ when thecompound represented by formula IV is administered in vivo, wherein R⁵is a straight or branched chain C₉ to C₂₄ alkylphosphate (e.g.,—OPO₃—C₁₈H₃₇) or a straight or branched chain C₉ to C₂₄ alkenylphosphategroup and wherein R¹ and R² are independently C₁ to C₁₀ alkyl or whereinR¹ and R² taken together with N form a C₃ to C₇ ring represented by thefollowing structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R² taken together with the N, are represented by thestructural formula:

along with pharmaceutical compositions thereof which further comprise apharmaceutically acceptable carrier. Also within the scope of thepresent invention is any compound represented by a structural formulaselected from the group consisting of XV-XXIII along withpharmaceutically acceptable salts thereof and pharmaceuticalcompositions thereof further comprising a pharmaceutically acceptablecarrier.

The scope of the present invention also includes compositions comprisinga compound represented by structural formula I:

or a pharmaceutically acceptable salt thereof; wherein R^(2′) and R^(3′)are independently —OH or a pharmaceutically acceptable leaving groupwhich is capable of being converted into phosphate, —OH, F or —CH₃ whenthe compound represented by formula I is administered in vivo, andR^(5′) is a straight or branched chain C₉ to C₂₄ alkylphosphate or astraight or branched chain C₉ to C₂₄ alkenylphosphate group or apharmaceutically acceptable leaving group which is capable of beingconverted into —OH or phosphate when the compound represented by formulaI is administered in vivo;) in association with one or more otheranti-viral substances (e.g., a kit), for example, any other anti-viralagent disclosed under the “Pharmaceutical Compositions” section below,including, but by no means limited to, ribavirin, PEG-interferonalfa-2a, PEG-interferon alfa-2b, interferon alfa-2a or interferonalfa-2b or any other anti-viral substance described infra; along withpharmaceutical compositions thereof further comprising apharmaceutically acceptable carrieror a compound represented by structural formula IV:

or a pharmaceutically acceptable salt thereof; wherein R³ and R⁴ areindependently —OH or a pharmaceutically acceptable leaving group whichis capable of being converted to phosphate, —OH, F or —CH₃ when thecompound represented by formula IV is administered in vivo, wherein R⁵is —OH, a straight or branched chain C₉ to C₂₄ alkylphosphate (e.g.,—OPO₃—C₁₈H₃₇) or a straight or branched chain C₉ to C₂₄ alkenylphosphategroup or a pharmaceutically acceptable leaving group which is capable ofbeing converted into —OH, phosphate, F or —CH₃ when the compoundrepresented by formula IV is administered in vivo; and wherein R¹ and R²are independently C₁ to C₁₀ alkyl or wherein R¹ and R² taken togetherwith N form a C₃ to C₇ ring represented by the following structuralformula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

(e.g., any compound represented by a structural formula selected fromVI-XXIII) optionally in association with one or more further anti-viralsubstances (e.g., a kit) for example, any other anti-viral agentdisclosed under the “Pharmaceutical Compositions” section belowincluding, but by no means limited to, ribavirin, PEG-interferonalfa-2a, PEG-interferon alfa-2b, interferon alfa-2a or interferonalfa-2b or any other anti-viral substance described infra; along withpharmaceutical compositions thereof further comprising apharmaceutically acceptable carrier.

Pharmaceutical Compositions

The present invention includes methods for using a pharmaceuticalcomposition comprising a compound of the present invention (e.g.,compound represented by a formula selected from I-XXIII) and apharmaceutically acceptable carrier for treating a Flaviviridaeinfection. The pharmaceutical compositions may be prepared by anymethods well known in the art of pharmacy; see, e.g., Gilman, et al.,(eds.) (1990), The Pharmacological Bases of Therapeutics, 8th Ed.,Pergamon Press; A. Gennaro (ed.), Remington's Pharmaceutical Sciences,18th Edition, (1990), Mack Publishing Co., Easton, Pa.; Avis, et al.,(eds.) (1993) Pharmaceutical Dosage Forms: Parenteral MedicationsDekker, New York; Lieberman, et al., (eds.) (1990) Pharmaceutical DosageForms: Tablets Dekker, New York; and Lieberman, et al., (eds.) (1990),Pharmaceutical Dosage Forms: Disperse Systems Dekker, New York.

A pharmaceutical composition containing a compound of the presentinvention (e.g., represented by a formula selected from I-XXIII) can beprepared using conventional pharmaceutically acceptable excipients andadditives and conventional techniques. Such pharmaceutically acceptableexcipients and additives include non-toxic compatible fillers, binders,disintegrants, buffers, preservatives, anti-oxidants, lubricants,flavorings, thickeners, coloring agents, emulsifiers and the like. Allroutes of administration are contemplated including, but not limited to,parenteral (e.g., subcutaneous, intravenous, intraperitoneal,intramuscular) and non-parenteral (e.g., oral, transdermal, intranasal,intraocular, sublingual, inhalation, rectal and topical).

Unit forms of administration include oral forms such as tablets,capsules, powders, cachets, granules and solutions or suspensions,sublingual and buccal forms of administration, aerosols, implants,subcutaneous, intramuscular, intravenous, intranasal, intraocular,subcutaneous or rectal forms of administration.

When a solid composition is prepared in the form of tablets, e.g., awetting agent such as sodium lauryl sulfate can be added to micronizedor non-micronized compounds and mixed with a pharmaceutical vehicle suchas silica, gelatin starch, lactose, magnesium stearate, talc, gum arabicor the like. The tablets can be coated with sucrose, various polymers,or other appropriate substances. Tablets can be treated so as to have aprolonged or delayed activity and so as to release a predeterminedamount of active principle continuously or at predetermined intervals,e.g., by using ionic resins and the like.

A preparation in the form of gelatin capsules may be obtained, e.g., bymixing a compound of the present invention (e.g., represented by aformula selected from I-XXIII) with a diluent, such as a glycol or aglycerol ester, and incorporating the resulting mixture into soft orhard gelatin capsules.

A preparation in the form of a syrup or elixir can contain a compound ofthe present invention (e.g., represented by a formula selected fromI-XXIII), e.g., with a sweetener, methylparaben and propylparaben asantiseptics, flavoring agents and an appropriate color.

Water-dispersible powders or granules can contain a compound of thepresent invention (e.g., represented by a formula selected from I-XXIII)mixed, e.g., with dispersants, wetting agents or suspending agents, suchas polyvinylpyrrolidone, as well as with sweeteners and/or otherflavoring agents.

Rectal administration may be provided by using suppositories which maybe prepared, e.g., with binders melting at the rectal temperature, forexample cocoa butter or polyethylene glycols.

Parenteral, intranasal or intraocular administration may be provided byusing, e.g., aqueous suspensions, isotonic saline solutions or sterileand injectable solutions containing pharmacologically compatibledispersants and/or solubilizers, for example, propylene glycol orpolyethylene glycol.

Thus, to prepare an aqueous solution for intravenous injection, it ispossible to use a co-solvent, e.g., an alcohol such as ethanol or aglycol such as polyethylene glycol or propylene glycol, and ahydrophilic surfactant such as Tween® 80. An oily solution injectableintramuscularly can be prepared, e.g., by solubilizing the activeprinciple with a triglyceride or a glycerol ester.

Topical administration can be provided by using, e.g., creams, ointmentsor gels.

Transdermal administration can be provided by using patches in the formof a multilaminate, or with a reservoir, containing an a compound of theinvention (e.g., represented by a formula selected from I-XXIII) and anappropriate solvent.

Administration by inhalation can be provided by using, e.g., an aerosolcontaining sorbitan trioleate or oleic acid, for example, together withtrichlorofluoromethane, dichlorofluoromethane, dichlorotetrafluoroethaneor any other biologically compatible propellant gas; it is also possibleto use a system containing a compound of the present invention (e.g.,represented by a formula selected from I-XXIII), by itself or associatedwith an excipient, in powder form.

A compound of the present invention (e.g., represented by a formulaselected from I-XXIII) can also be formulated as microcapsules ormicrospheres, e.g., liposomes, optionally with one or more carriers oradditives.

Implants are among the prolonged release forms which can be used in thecase of chronic treatments. They can be prepared in the form of an oilysuspension or in the form of a suspension of microspheres in an isotonicmedium.

Methods of the present invention can include administration of acompound of the present invention (e.g., represented by a formulaselected from I-XXIII) in association with, for example, one or moreother anti-viral agents. The administration and dosage of such agents istypically as according to the schedule listed in the product informationsheet of the approved agents, in the Physicians' Desk Reference 2003(Physicians' Desk Reference, 57th Ed); Medical Economics Company; ISBN:1563634457; 57th edition (November 2002), as well as therapeuticprotocols well known in the art. Furthermore, the present inventionincludes compositions comprising a compound represented by structuralformula IV (e.g., as described herein) in association with one or moreother anti-viral agents (e.g., any of those described herein); in anembodiment of the invention, the compound represented by structuralformula IV is a compound represented by a structural formula selectedfrom the group consisting of formulas VI-XXIII.

Suitable other anti-viral agents include, but are not limited to,pegylated or unpegylated interferon alfa-2a, pegylated or unpegylatedinterferon alfa-2b, pegylated or unpegylated interferon alfa-2c,pegylated or unpegylated interferon alfa n-1, pegylated or unpegylatedinterferon alfa n-3 and pegylated, unpegylated consensus interferon oralbumin-interferon-alpha.

The term “interferon alpha” as used herein means the family of highlyhomologous species-specific proteins that inhibit viral replication andcellular proliferation and modulate immune response. Typical suitableinterferon-alphas include, but are not limited to, recombinantinterferon alpha-2b, recombinant interferon alpha-2a, recombinantinterferon alpha-2c, alpha 2 interferon, interferon alpha-n1 (INS), apurified blend of natural alpha interferons, a consensus alphainterferon such as those described in U.S. Pat. Nos. 4,897,471 and4,695,623 (especially Examples 7, 8 or 9 thereof), or interferonalpha-n3, a mixture of natural alpha interferons.

Interferon alfa-2a is sold as ROFERON-A® by Hoffmann-La Roche (Nutley,N.J.).

Interferon alfa-2b is sold as INTRON-A® by Schering Corporation(Kenilworth, N.J.). Interferon alfa-2b is also sold, in combination withribavirin, as REBETRON® by Schering Corporation (Kenilworth, N.J.). Themanufacture of interferon alpha 2b is described, for example, in U.S.Pat. No. 4,530,901.

Interferon alfa-n3 is a mixture of natural interferons sold as ALFERON NINJECTION® by Hemispherx Biopharma, Inc. (Philadelphia, Pa.).

Interferon alfa-n1 (INS) is a mixture of natural interferons sold asWELLFERON® by Glaxo-Smith-Kline (Research Triangle Park, N.C.).

Consensus interferon is sold as INFERGEN® by Intermune, Inc. (Brisbane,Calif.).

Interferon alfa-2c is sold as BEROFOR® by Boehringer IngelheimPharmaceutical, Inc. (Ridgefield, Conn.).

A purified blend of natural interferons is sold as SUMIFERON® bySumitomo; Tokyo, Japan.

Pegylated interferon alpha may also be administered in association witha compound of the invention (e.g., represented by a formula selectedfrom I-XXIII). The term “pegylated interferon alpha” as used hereinmeans polyethylene glycol modified conjugates of interferon alpha,preferably interferon alpha-2a and alpha-2b. The preferredpolyethylene-glycol-interferon alpha-2b conjugate is PEG12000-interferon alpha-2b. The phrases “12,000 molecular weightpolyethylene glycol conjugated interferon alpha” and “PEG 12000-IFNalpha” as used herein include conjugates such as are prepared accordingto the methods of International Application No. WO 95/13090 andcontaining urethane linkages between the interferon alpha-2a or -2bamino groups and polyethylene glycol having an average molecular weightof 12000. The pegylated interferon alpha, PEG 12000-IFN-alpha-2b isavailable from Schering-Plough Research Institute, Kenilworth, N.J.

The preferred PEG 12000-interferon alpha-2b can be prepared by attachinga PEG polymer to the epsilon amino group of a lysine residue in theinterferon alpha-2b molecule. A single PEG 12000 molecule can beconjugated to free amino groups on an IFN alpha-2b molecule via aurethane linkage. This conjugate is characterized by the molecularweight of PEG 12000 attached. The PEG 12000-IFN alpha-2b conjugate canbe formulated as a lyophilized powder for injection.

Pegylated interferon alfa-2b is sold as PEG-INTRON® by ScheringCorporation (Kenilworth, N.J.).

Pegylated interferon-alfa-2a is sold as PEGASYS® by Hoffmann-La Roche(Nutley, N.J.).

Other interferon alpha conjugates can be prepared by coupling aninterferon alpha to a water-soluble polymer. A non-limiting list of suchpolymers include other polyalkylene oxide homopolymers such aspolypropylene glycols, polyoxyethylenated polyols, copolymers thereofand block copolymers thereof. As an alternative to polyalkyleneoxide-based polymers, effectively non-antigenic materials such asdextran, polyvinylpyrrolidones, polyacrylamides, polyvinyl alcohols,carbohydrate-based polymers and the like can be used. Such interferonalpha-polymer conjugates are described, for example, in U.S. Pat. No.4,766,106, U.S. Pat. No. 4,917,888, European Patent Application No. 0236 987 or 0 593 868 or International Publication No. WO 95/13090.

Pharmaceutical compositions of pegylated interferon alpha suitable forparenteral administration can be formulated with a suitable buffer,e.g., Tris-HCl, acetate or phosphate such as dibasic sodiumphosphate/monobasic sodium phosphate buffer, and pharmaceuticallyacceptable excipients (e.g., sucrose), carriers (e.g. human plasmaalbumin), toxicity agents (e.g., NaCl), preservatives (e.g., thimerosol,cresol or benzyl alcohol), and surfactants (e.g., tween or polysorbates)in sterile water for injection. The pegylated interferon alpha can bestored as lyophilized powders under refrigeration at 2°-8° C. Thereconstituted aqueous solutions are stable when stored between 2° and 8°C. and used within 24 hours of reconstitution. See for example U.S. Pat.Nos. 4,492,537; 5,762,923 and 5,766,582. The reconstituted aqueoussolutions may also be stored in prefilled, multi-dose syringes such asthose useful for delivery of drugs such as insulin. Typical, suitablesyringes include systems comprising a prefilled vial attached to apen-type syringe such as the NOVOLET® Novo Pen available from NovoNordisk or the REDIPEN®, available from Schering Corporation,Kenilworth, N.J. Other syringe systems include a pen-type syringecomprising a glass cartridge containing a diluent and lyophilizedpegylated interferon alpha powder in a separate compartment.

In an embodiment of the invention, one or more other anti-viralsubstances may be administered with one or more compounds of theinvention (e.g., represented by a structural formula selected fromI-XXIII). For example, a compound of the invention (e.g., represented bya formula selected from I-XXIII) may be administered withinterferon-alfa, pegylated interferon-alfa or albumin-interferon.

Other types of compounds which may be administered with a compound ofthe invention (e.g., represented by a structural formula selected fromI-XXIII) include ribonucleoside analogues, IMPDH inhibitors,N-glycosylation inhibitors, N3 protease inhibitors, NS5B inhibitors,immunomodulatory compounds and CTP synthase inhibitors, thiazolidinederivatives, benzanilides, phenanthrenequinones, helicase inhibitors,polymerase inhibitors, antisense phosphothioate oligodeoxynucleotides,IRES-dependent translation inhibitors, nuclease resistant ribozymes,1-amino-alkyloyclohexanes, alkyl lipids, antioxidants, squalene,amantadine, bile acids, N-(phosphonoacetyl)-L-aspartic acid,benzenedicarboxamides, polyadenylic acid derivatives, 2′,3′dideoxyinosine and benzimidazoles.

In an embodiment of the present invention, ribavirin

1-β-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide) is administered inassociation with a compound of the present invention (e.g., representedby a formula selected from I-XXIII). Ribavirin is sold as REBETOL® bySchering Corporation; Kenilworth, N.J. Its manufacture and formulationis described, for example, in U.S. Pat. No. 4,211,771. A combination ofribavirin and recombinant interferon alfa-2b (REBETRON®; ScheringCorporation; Kenilworth, N.J.) may also be administered in associationwith a compound of the invention (e.g., represented by a formulaselected from I-XXIII).

In another embodiment of the invention, gemcitabine

is administered in association with a compound of the present invention(e.g., represented by a formula selected from I-XXIII). Gemcitabine issold as GEMZAR® by Eli Lilly and Co. (Indianapolis, Ind.).

A further embodiment of the present invention comprises administering acompound of the invention (e.g., represented by a formula selected fromI-XXIII) in association with VX497

Vertex Pharmaceuticals; Cambridge, Mass.).

An embodiment of the invention comprises administering mycophenolatemofetil (MMF; 2-morpholinoethyl(E)-6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-4-hexenoate)in association with a compound of the invention (e.g., represented by aformula selected from I-XXIII). MMF is sold as CellCept® by RocheLaboratories; Nutley, N.J.

Another embodiment comprises administering EICAR

5-ethynyl-1-beta-D-ribofuranosyl imidazole-4-carboxamide; Balzarini etal., J. Biol. Chem. 268(33): 24591-24598 (1993)) in association with acompound of the invention (e.g., represented by a formula selected fromI-XXIII).

An embodiment of the present invention comprises administeringtiazofurin

Balzarini et al., J. Biol. Chem. 268(33): 24591-24598 (1993)) inassociation with a compound of the invention (e.g., represented by aformula selected from I-XXIII).

Another embodiment of the invention comprises administeringdeoxynojirimycin and/or derivatives thereof, such asN-nonyl-deoxynojirimycin (De Clercq et al., Mini Rev Med. Chem.2(2):163-75 (2002)) or n-butyl deoxynojirimycin (nB-DNJ; Ouzounov etal., Antiviral Res. 55(3):425-35 (2002)), in association with a compoundof the invention (e.g., represented by a formula selected from I-XXIII).

In one embodiment, a compound of the present invention (e.g.,represented by a formula selected from I-XXIII) is administered inassociation with albumin-interferon alpha (ALBUFERON™).Albumin-interferon alpha is interferon-a fused to human serum albumin.ALBUFERON™ is available from Human Genome Sciences, Rockville, Md.ALBUFERON™ has been shown to be effective for treatment of hepatitis Cvirus infections (Blaire et al., J. Pharm and Exp. Therap. 303(2):540-548 (2002)).

In another embodiment, BILN-2061

Lamarre et al., Nature 426(6963):129-31 (2003)), is administered inassociation with a compound of the present invention (e.g., representedby a formula selected from I-XXIII).

In another embodiment, thymalfasin (e.g., ZADAXIN™) is administered inassociation with a compound of the invention (e.g., represented by aformula selected from I-XXIII). ZADAXIN™ is available from SciClonePharmaceuticals International, Ltd., San Mateo, Calif.

In yet another embodiment, isatoribine

ANA245;5-Amino-3-beta-D-ribofuranosylthiazolo(4,5-d)pyrimidine-2,7(3H,6H)—dione monohydrate; Thiazolo(4,5-d)pyrimidine-2,7(3H,4H)-dione,5-amino-3-beta-D-ribofuranosyl-, monohydrate) is administered inassociation with a compound of the invention (e.g., represented by aformula selected from I-XXIII).

In another embodiment, a compound of the invention (e.g., represented bya formula selected from I-XXIII) is administered in association with anNS5B inhibitor such as NM283 or NM107 (Idenix Pharmaceuticals;Cambridge, Mass.).

In another embodiment, a compound of the invention (e.g., represented bya formula selected from I-XXIII) is administered in association withSCH68631

Chu et al., Tetrahedron Letters 37(40): 7229-7232 (1996)) or SCH₃₅₁₆₃₃

Biorg. Med. Chem. Lett. 9(14): 1949-1952 (1999)).

In a further embodiment, a compound of the invention (e.g., representedby a formula selected from I-XXIII) is administered in association withany of the P₁ variants of Elgin c disclosed in Qasim et al.,Biochemistry 36: 1598-1607 (1997).

In yet another embodiment, a compound of the invention (e.g.,represented by a formula selected from I-XXIII) is administered inassociation with gliotoxin

Ferrari et al., J. Virology 73(2): 1649-1654 (1999)).

Other embodiments of the invention include administering a compound ofthe present invention (e.g., represented by a formula selected fromI-XXIII) in association with RD3-4082

Sudo et al., Anti-viral Chem. & Chemother. 9: 186 (1998)) or withRD3-4078

Sudo et al., Anti-viral Chem. & Chemother. 9: 186 (1998)) or any otherprotease inhibitor disclosed in Sudo et al.

A further embodiment of the invention comprises administering a compoundof the present invention (e.g., represented by a structural formulaselected from I-XXIII) in association with

Kakiuchi et al., FEBS Letters 421: 217-220 (1998)) or any otherproteinase inhibitor disclosed in Kakiuchi et al.

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with RD4-6205

Sudo et al., Biochem. Biophys. Res. Comm. 238: 643-647 (1997)) or anyother protease inhibitor disclosed in Sudo et al.

An embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with cerulenin

CAS Registry No. 17397-89-6; Lohmann et al., Virology 249: 108-118(1998)) or any other HCV RNA-dependent RNA polymerase (RdRp) inhibitordisclosed in Lohmann et al.

An embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with ceplene

2-(1H-Imidazol-4-yl)ethanamine dihydrochloride).

Yet another embodiment of the present invention comprises administeringa compound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with amantadine

A further embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with IDN-6556

Yet another embodiment of the present invention comprises administeringa compound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with naphthoquinone,2-methylnaphthoquinone, 2-hydroxynaphthoquinone,5-hydroxynaphthoquinone, 5,8-dihydroxynaphthoquinone, alkannin orshikonin (Takeshita et al., Analytical Biochem. 247: 242-246 (1997)).

A further embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with1-amino-1,3,5-trimethylcyclohexane, 1-amino-1(trans),3(trans),5-trimethylcyclohexane, 1-amino-1(cis),3(cis),5-trimethylcyclohexane,1-amino-1,3,3,5-tetramethylcyclohexane,1-amino-1,3,3,5,5-pentamethylcyclohexane,1-amino-1,3,5,5-tetramethyl-3-ethylcyclohexane,1-amino-1,5,5-trimethyl-3,3-diethylcyclohexane,1-amino-1,5,5-trimethyl-cis-3-ethylcyclohexane,1-amino-(1S,5S)cis-3-ethyl-1,5,5-trimethylcyclohexane,1-amino-1,5,5-trimethyl-trans-3-ethylcyclohexane,1-amino-(1R,5S)trans-3-ethyl-1,5,5-trimethylcyclohexane,1-amino-1-ethyl-3,3,5,5-tetramethylcyclohexane,1-amino-1-propyl-3,3,5,5-tetramethylcyclohexane,N-methyl-1-amino-1,3,3,5,5-pentamethylcyclohexane,N-ethyl-1-amino-1,3,3,5,5-pentamethylcyclohexane, orN-(1,3,3,5,5-pentamethylcyclohexyl)pyrrolidine or any other1-aminoalkylcyclohexane N-methyl-D-aspartate (NMDA) inhibitors disclosedin U.S. Pat. No. 6,034,134.

A further embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with d-α-tocopherol or anyother anti-HCV compound disclosed in U.S. Pat. No. 5,922,757.

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with tauroursodeoxycholicacid, chenodeoxycholic acid, ursodeoxycholic acid or free bile acid orany other bile acid HCV inhibitor disclosed in U.S. Pat. No. 5,846,964.

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-trans-(4,5,6,7,8,9-hexahydro)benzimidazoyl)piperidine,1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-benzimidazoyl)piperidine orany other anti-HCV compound disclosed in U.S. Pat. No. 5,830,905.

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association withN,N′-4-[(2-benzimidazole)phenyl]-1,4-butanedicarboxamide,N,N′-4-[(2-benzimidazole)phenyl]-1,6-hexanedicarboxamide,N,N′-4-[(2-benzimidazole)phenyl]-1,8-octanedicarboxamide,N,N′-4-[(2-benzimidazole)phenyl]-1,9-nonanedicarboxamide,N,N′-4-[(2-benzimidazole)phenyl]-1,10-decanedicarboxamide orN,N′-4-[(2-benzimidazole)phenyl]-1,4-butenedicarboxamide or any othercarboxamide HCV inhibitor disclosed in U.S. Pat. No. 5,633,388.

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with any of thepolyadenylic acid (5′) derivatives disclosed in U.S. Pat. No. 5,496,546.

A further embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with 2′,3′-dideoxyinosine(U.S. Pat. No. 5,026,687).

An embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with

any other benzimidazole disclosed in U.S. Pat. No. 5,891,874.

An additional embodiment of the invention comprises administering VX-950

Lin et al., J. Biol. Chem. 279(17): 17508-17514 (2004)) in associationwith a compound of the present invention (e.g., represented by astructural formula selected from I-XXIII).

Another embodiment of the present invention comprises administering acompound of the present invention (e.g., represented by a structuralformula selected from I-XXIII) in association with viramidine

or levovirin

Combinations of the invention include a compound of the presentinvention (e.g., represented by a structural formula selected fromI-XXIII) “in association” with one or more additional anti-viral agents(e.g., ribavirin, interferon alfa-2a or 2b, or pegylated interferonalfa-2a or 2b). The term “in association” indicates that the componentsof the combinations of the invention can be formulated into a singlecomposition for simultaneous delivery or formulated separately into twoor more compositions (e.g., a kit). Furthermore, each component of acombination of the invention can be administered to a subject at adifferent time than when the other component is administered; forexample, each administration may be given non-simultaneously (e.g.,separately or sequentially) at several intervals over a given period oftime. Moreover, the separate components may be administered to a subjectby the same or by a different route (e.g., orally, intravenously,subcutaneously).

The present invention further comprises compositions comprising acompound of the present invention (e.g., represented by structuralformula selected from I-XXIII) in association with one or moreanti-viral agents discussed above (e.g., pegylated interferon alfa-2a or2b or ribavirin) along with pharmaceutical compositions thereof.

Dosage and Administration

Typical protocols for the therapeutic administration of such substancesare well known in the art. Pharmaceutical composition of the inventionmay be administered, for example, by any parenteral (e.g., subcutaneousinjection, intramuscular injection, intravenous injection) ornon-parenteral route (e.g., orally, nasally).

Pills and capsules of the invention can be administered orally.Injectable compositions can be administered with medical devices knownin the art; for example, by injection with a hypodermic needle includingthe REDIPEN® or the NOVOLET® Novo Pen discussed above.

Injectable pharmaceutical compositions of the invention may also beadministered with a needleless hypodermic injection device; such as thedevices disclosed in U.S. Pat. No. 5,399,163; 5,383,851; 5,312,335;5,064,413; 4,941,880; 4,790,824 or 4,596,556.

Compounds of the invention can be administered, for example, three timesa day, twice a day, once a day, three times weekly, twice weekly or onceweekly.

In an embodiment, the daily dose of a compound of the present invention(e.g., represented by a formula selected from 1-XXIII) or of any otheranti-viral agent administered in association with a compound of theinvention (e.g., represented by a formula selected from I-XXIII) is,where possible, administered accordance with the Physicians' DeskReference 2003 (Physicians' Desk Reference, 57th Ed); Medical EconomicsCompany; ISBN: 1563634457; 57th edition (November 2002). The properdosage can, however, be altered by a clinician to compensate forparticular characteristics of the subject receiving the therapydepending, for example, on the potency of the compound administered,side-effects, age, weight, medical condition, overall health andresponse.

The term “therapeutically effective amount” means that amount of atherapeutic agent or substance (e.g., compound represented by structuralformula selected from I-XXIII, interferon or ribavirin) that will elicita biological or medical response of a tissue, system, subject or hostthat is being sought by the administrator (such as a researcher, doctoror veterinarian) which includes alleviation of the symptoms ofFlaviviridae virus (e.g., HCV) infection and the prevention, slowing orhalting of progression of Flaviviridae virus (e.g., HCV) infection andits symptom(s) to any degree including prevention of the infection of ahost with a Flaviviridae virus (e.g., HCV) following transplant of aliver into said host. For example, in one embodiment, a “therapeuticallyeffective dosage” of a compound of the invention (e.g., represented by astructural formula selected from I-XXIII) or a combination includinganother anti-viral agent (e.g., ribavirin and/or pegylated orunpegylated inferferon alfa-2a or 2b) results in the eradication ofdetectable Flaviviridae Viral RNA (e.g., HCV RNA) for any period oftime, for example, 12 or more weeks (e.g., 24 weeks). Detection of viralRNA in a host can be done easily using conventional well-known methodsin the art. See also the Physicians' Desk Reference (“PDR”) for thetherapeutically effective dose and dosage regimens approved by the U.S.Federal Food and Drug Administration.

In an embodiment, a therapeutically effective dosage or amount of acompound represented by a structural formula selected from I-III isabout 20 mg/day to about 800 mg per day; about 20 mg/day to about 600 mgper day; about 20 mg/day to about 400 mg per day; about 20 mg/day toabout 100 mg per day; about 60 mg/day to about 800 mg per day; about 60mg/day to about 600 mg per day; about 60 mg/day to about 400 mg per day;about 60 mg/day to about 200 mg per day; or about 60 mg/day to about 100mg per day. For example, a compound of the invention (e.g., representedby a formula selected from I-III) can be administered in a dosage formcontaining from about 20 mg to about 800 mg of the compound (e.g., 20mg, 50 mg, 100 mg, 200 mg, 400 mg, 600 mg or 800 mg).

In an embodiment, a therapeutically effective amount or dosage acompound represented by a structural formula of any of IV-XXIII is about80 mg/day to about 1200 mg per day; about 80 mg/day to about 120 mg perday; about 80 mg/day to about 400 mg per day; about 80 mg/day to about600 mg per day; or about 80 mg/day to about 1000 mg per day. Forexample, a compound of the invention (e.g., represented by a formulaselected from IV-XXIII) can be administered in a dosage form containingfrom about 20 mg to about 1200 mg of the compound (e.g., 20 mg, 80 mg,120 mg, 400 mg, 600 mg, 1000 mg or 1100 mg).

As discussed herein, methods of the present invention can includeadministering a compound comprising a structural formula selected fromI-XXIII along with pegylated or unpegylated interferon alfa-2a,pegylated or unpegylated interferon alfa-2b, pegylated or unpegylatedinterferon alfa-2c, pegylated or unpegylated interferon alfa n-1,pegylated or unpegylated interferon alfa n-3, unpegylated pegylatedconsensus interferon, ribavirin or any combination thereof.

In an embodiment, a therapeutically effective dosage of interferonalfa-2b (e.g., INTRON-A®), particularly for the treatment of chronichepatitis C is 3 million IU (international units) three times a week(TIW) administered subcutaneously or intramuscularly. In patientstolerating therapy with normalization of serum alanine aminotransferase(ALT) at 16 weeks of treatment, INTRON A® therapy should be extended to18 to 24 months (72 to 96 weeks) at 3 million IU TIW to improve thesustained response rate.

If severe adverse reactions develop during INTRON A® treatment, the doseshould be modified (50% reduction) or therapy should be discontinued asindicated below. If intolerance persists after dose adjustment, INTRONA® therapy should be discontinued.

In an embodiment, the recommended dose of PEG-interferon alfa-2b (e.g.,PEG-INTRON®) regimen is from about 0.5 to about 1.5 μg/kg/week,preferably 1.0 μg/kg/week for one year.

In an embodiment, a therapeutically effective dosage of interferonalfa-2a (e.g., ROFERON-A®), particularly for the treatment of chronichepatitis C, is 3 MIU three times a week (TIW) administeredsubcutaneously or intramuscularly for 12 months (48 to 52 weeks). As analternative, patients may be treated with an induction dose of 6 MIU TIWfor the first 3 months (12 weeks) followed by 3 MIU TIW for 9 months (36weeks).

Patients who tolerate and partially or completely respond to therapywith ROFERON-A® but relapse following its discontinuation may bere-treated. Re-treatment with either 3 MIU TIW or with 6 MIU TIW for 6to 12 months may be considered.

In an embodiment, a temporary dose reduction by 50% is recommended inpatients who do not tolerate the prescribed dose of ROFERON-A®. Ifadverse events resolve, treatment with the original prescribed dose canbe re-initiated. In patients who cannot tolerate the reduced dose,cessation of therapy, at least temporarily, is recommended.

In an embodiment, the recommended dose of PEG-interferon alfa-2a (e.g.,PEGASYS®) monotherapy is 180 μg (1.0 mL) once weekly for 48 weeks bysubcutaneous (SC) administration in the abdomen or thigh.

In an embodiment, a therapeutically effective dosage of consensusinterferon alfa (e.g., INFERGEN®), particularly for treatment of chronicHCV infection, is 9 mcg TIW administered SC as a single injection for 24weeks. At least 48 hours should elapse between doses of INFERGEN®.

In an embodiment, patients who tolerated previous interferon therapy anddid not respond or relapsed following its discontinuation may besubsequently treated with 15 mcg of INFERGEN® TIW administered SC as asingle injection for up to 48 weeks.

In an embodiment, for patients who experience a severe adverse reactionon INFERGEN®, dosage should be withheld temporarily. If the adversereaction does not become tolerable, therapy should be discontinued. Dosereduction to 7.5 mcg may be necessary following an intolerable adverseevent.

If adverse reactions continue to occur at the reduced dosage, thephysician may discontinue treatment or reduce dosage further. However,decreased efficacy may result from continued treatment at dosages below7.5 mcg.

During subsequent treatment for 48 weeks with 15 mcg of INFERGEN®, up to36% of patients required dose reductions in 3 mcg increments.

In an embodiment, a therapeutically effective does ofalbumin-interferon-alpha (e.g., ALBUFERON®) is about 120 mcg or about180 mcg or about 240 mcg or about 320 mcg or about 400 mcg or about 500mcg per day subcutaneously.

In an embodiment, a therapeutically effective dose of ribavirin (e.g.,REBETROL®) depends on the patient's body weight. In an embodiment, therecommended dose of REBETOL® is provided, below, in Table 1.

TABLE 1 Recommended Dosing Body weight REBETOL Capsules </=75 kg 2 ×200-mg capsules AM, 3 × 200-mg capsules PM daily p.o. >75 kg 3 × 200 mgcapsules AM, 3 × 200 mg capsules PM daily p.o.

In an embodiment, the recommended duration of treatment with ribavirin(e.g., REBETOL®) for patients previously untreated with interferon is 24to 48 weeks. The duration of treatment should be individualized to thepatient depending on baseline disease characteristics, response totherapy, and tolerability of the regimen. After 24 weeks of treatment,virologic response should be assessed. Treatment discontinuation shouldbe considered in any patient who has not achieved an HCV RNA below thelimit of detection of the assay by 24 weeks.

In an embodiment, in patients who relapse following interferon therapy,the recommended duration of treatment with ribavirin (e.g., REBETOL®) is24 weeks.

REBETOL® may be administered without regard to food, but should beadministered in a consistent manner with respect to food intake.

In an embodiment, a combination of interferon alfa-2b and ribavirin(e.g., REBETRON®) is administered in association with a compound of theinvention (e.g., represented by a formula selected from I-XXIII).

In an embodiment, the recommended duration of REBETRON® treatment forpatients previously untreated with interferon is 24 to 48 weeks. Theduration of treatment should be individualized to the patient dependingon baseline disease characteristics, response to therapy, andtolerability of the regimen. After 24 weeks of treatment, virologicresponse should be assessed. Treatment discontinuation should beconsidered in any patient who has not achieved an HCV RNA below thelimit of detection of the assay by 24 weeks. In patients who relapsefollowing interferon therapy, the recommended duration of treatment is24 weeks.

In an embodiment, the recommended dosage of a combination of ribavirin(e.g., REBETROL®) and interferon alfa-2b (e.g., INTRON-A®) depends onpatient body weigh. In an embodiment, the adult dosage regimen is setforth below in Table 2:

TABLE 2 Recommended Adult Dosing Body weight REBETOL Capsules INTRON AInjection </=75 kg 2 × 200-mg capsules AM, 3 million IU 3 times 3 ×200-mg capsules PM weekly s.c. daily p.o. >75 kg 3 × 200-mg capsules AM,3 million IU 3 times 3 × 200-mg capsules PM weekly s.c. daily p.o.

In an embodiment, the pediatric dosage regimen, for the combination, isset forth below in Table 3:

TABLE 3 Pediatric Dosing Body weight REBETOL Capsules INTRON A Injection25-36 kg 1 × 200-mg capsule AM 3 million IU/m² 3 times 1 × 200-mgcapsule PM weekly s.c. daily p.o. 37-49 kg 1 × 200-mg capsule AM 3million IU/m² 3 times 2 × 200-mg capsules PM weekly s.c. daily p.o.50-61 kg 2 × 200-mg capsules AM 3 million IU/m² 3 times 2 × 200-mgcapsules PM weekly s.c. daily p.o. >61 kg Refer to adult dosing tableRefer to adult dosing table

In an embodiment, dosage modification of REBETOL®/INTRON-A® treatment isindicated when adverse reactions are observed in the patient. Forexample, in patients with a history of stable cardiovascular disease, apermanent dose reduction is required if the patient's hemoglobindecreases by >/=2 g/dL during any 4-week period. In addition, for thesecardiac history patients, if the patient's hemoglobin remains <12 g/dLafter 4 weeks on a reduced dose, the patient should discontinuecombination REBETOL®/INTRON-A® therapy.

In an embodiment, it is recommended that a patient whose hemoglobinlevel falls below 10 g/dL have his/her REBETOL® dose reduced to 600 mgdaily (1×200-mg capsule AM, 2×200-mg capsules PM). A patient whosehemoglobin level falls below 8.5 g/dL should be permanently discontinuedfrom REBETOL®/INTRON A® therapy.

In an embodiment, when administered in combination with REBETOL®, therecommended dose of PEG-Intron® is 1.5 micrograms/kg/week. Therecommended dose of REBETOL® is 800 mg/day in 2 divided doses: twocapsules (400 mg) with breakfast and two capsules (400 mg) with dinner.REBETOL® should not be used in patients with creatinine clearance <50mL/min.

Ideally, though not necessarily, an infected host who is administered acomposition of the invention will, eventually, exhibit no detectable HCVRNA is his body for a period of time (e.g., 12 or more weeks).

The term “no detectable HCV-RNA” in the context of the present inventionmeans that there is less than about 100 copies of HCV-RNA per ml ofserum of the patient as measured by quantitative, multi-cycle reversetranscriptase PCR (rtPCT) methodology. Such PCR based assays areconventional and very well known in the art. In general, rtPCR isperformed by isolating the RNA from a specimen, reverse-transcribing itto generate cDNAs, amplifying specific nucleic acid sequences by PCR,and then using a variety of methods to detect the amplified sequences(Urdea et al., Clin. Chem. 43:1507-1511 (1997)).

In one embodiment, a method of the present invention, when administeredto a host infected with a Flaviviridae virus, will exhibit a sustainedvirologic response. The term “sustained virologic response” as used inthe context of the present invention means that there is no detectableHCV-RNA in the serum of patients treated in accordance with the presentinvention for at least 24 weeks after the end of the combined therapytreatment. Preferably, the period of sustained virologic response is atleast one year—or longer—after the end of treatment.

EXAMPLES

The following examples are intended to exemplify and further clarifywhat is the present invention and should not be construed to limit thepresent invention.

Example 1 Production of Ara-C-5′-stearylphosphate (III) andAra-C-5′-stearylphosphate Monosodium Salt

To 6.4 g (10 mmol) of N⁴,O^(2′),O^(3′)-triacetyl-Ara-C-5′-phosphatetri-n-butyl ammonium salt, 5 g of stearyl alcohol, 30 ml of pyridine and8 g of p-toluenesulfonyl chloride were added and the mixture wasmaintained at 40° C. for 3 hours. Then, the reaction mixture wasextracted after adding 50 ml of water and 50 ml of chloroform.

Deacetylation of the triacetyl compound in the chloroform solution wascarried out by adding 20 ml of aqueous ammonia and ethanol thereto andthe deacetylated compound was extracted with water.

After collecting the aqueous layer, the aqueous layer was adjusted to pH2.5 by adding conc. hydrochloric acid, and the precipitatedAra-C-5′-stearylphosphate was collected by filtration. After adding 20ml of water to the thus obtained precipitates and adjusting the solutionto pH 10.5 by an aqueous 1N solution of sodium hydroxide, 80 ml ofethanol were added to the solution. By collecting the generatedprecipitate through filtration, Ara-C-5′-stearylphosphate monosodiumsalt (α-type) was obtained in wet state, and by drying the wet materialin the same manner as in Example 2, 4.20 g of Ara-C-5′-stearylphosphatemonosodium salt α-type) of m.p. 221° C. (decomposition) were obtained.

The purity of the thus obtained product was 99.62% by liquidchromatography and E₁ cm^(1%) (273 nm, 0.1N NaOH) was 151.4. Thisprocedure is taken from U.S. Pat. No. 4,812,560.

Example 2 Production of Ara-C-5′-stearylphosphate Monosodium Salt

Into 1.5 liters of water 500 g of Ara-C-5′-stearylphosphate were addedand after adjusting the pH of the mixture to 10.8 by sodium hydroxidewhile stirring the mixture, 6 liters of ethanol were added to themixture. After allowing the mixture to cool for 16 hours, the thusformed precipitate was collected by centrifugation to obtainAra-C-5′-stearylphosphate monosodium salt in wet state.

By drying the thus obtained wet salt at 30° C. under reduced pressure,332 g of amorphous (α-type) Ara-C-5′-stearylphosphate monosodium salt ofm.p. 223° C. (decomposition) were obtained.

The purity of the thus obtained product was 99.5% according to liquidchromatography and E₁ cm^(1%) (273 nm, 0.1N NaOH) was 152. 3.

The same result as above was obtained when acetone, methyl ethyl ketone,tetrahydrofurane or dioxane was added instead of ethanol to precipitatethe monosodium salt. This procedure is taken from U.S. Pat. No.4,812,560.

Example 3 Production of Ara-C-5′-stearylphosphate Monosodium Salt

To 2.40 g of Ara-C-5′-stearylphosphate (a dried material), 6 ml of waterwere added and, after adjusting the mixture to pH 12.0 with aqueous 1Nsolution of sodium hydroxide, 30 ml of ethanol were added to the mixtureand the mixture was stirred for 3 hours at 55° C. After cooling themixture for 16 hours by standing, the precipitate was collected byfiltration and dried for 10 hours at 30° C. under a reduced pressure toobtain 1.83 g of Ara-C-5′-stearylphosphate monosodium salt (α-type) ofm.p. 220° C. (decomposition). The purity of the thus obtained productwas 99.5% according to liquid chromatography and E₁ cm^(1%) (273 nlm,0.1N NaOH) was 150.9. This procedure is taken from U.S. Pat. No.4,812,560.

Example 4 Production of Ara-C-5′-stearylphosphate Monosodium Salt

To 2.40 g of Ara-C-5′-stearylphosphate, 10 ml of water were added and,after adjusting the mixture to pH 10.0 by sodium hydroxide whilestirring, the mixture, the thus formed solution was condensed to drynessunder a reduced pressure to obtain 2.30 g of Ara-C-5′-stearylphosphatemonosodium salt (α-type).

The melting point of the thus obtained product was 219.8° C.(decomposition), the purity thereof was 99.1% by liquid chromatographyand E₁ cm^(1%) (273 nm, 0.1N NaOH) was 152.6. This procedure is takenfrom U.S. Pat. No. 4,812,560.

Example 5 Ara-C-5′-stearylphosphate Monosodium Salt Monohydrate

To 10 g of Ara-C-5′-stearylphosphate, 30 ml of water were added and,after adjusting the pH of the mixture to 10.5 by 5N sodium hydroxide, 50ml of ethanol were added to the thus formed solution with stirring atabout 40° C. to precipitate the monosodium salt.

The mixture was heated to 65° C. and after adding the seed crystal ofAra-C-5′-stearylphosphate monosodium salt monohydrate (P-type), themixture was maintained with stirring while keeping the temperature for 5hours to form crystals. After microscopically confirming the completionof crystallization, 20 ml of ethanol were added to the mixture and themixture was gradually cooled.

After one night, the crystals were filtrated and by drying under areduced pressure 8.9 g of Ara-C-5′-stearylphosphate monosodium saltmonohydrate (crystals of P-type) of m.p. 220° C. (decomposition) wereobtained.

The purity of the thus obtained product was 99.7% by liquidchromatography and E₁ cm^(1%) (273 nm, 0.1N NaOH) was 153.0. Thisprocedure is taken from U.S. Pat. No. 4,812,560.

Example 6 Synthesis of N⁴-[(Dimethylamino)methylene]arabinocytidine (VI)

Ara-C (300 mg, 1.23 mmol) in DMF (5 mL) was reacted withdimethylformamide dimethyl acetal (1.7 g, 14.2 mmol). On evaporation andcrystallization from a minimum amount of ethanol, white crystals ofN⁴-[(Dimethylamino)methylene]arabinocytidine were obtained (371 mg,100%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 7 Synthesis of N⁴-[(Diethylamino)methylene]arabinocytidine (VII)

Ara-C (500 mg, 2.05 mmol) in DMF (2 mL) was reacted withdiethylformamide dimethyl acetal (2.16 g, 14.7 mmol). After evaporation,the recrystallization of the residue from a variety of solvents proveddifficult. The residue was finally crystallized from a solution of 4%MeOH in CH₂Cl₂, to give N⁴-[(Diethylamino)methylene]arabinocytidine asfine colorless, whitish crystals (601 mg, 90%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 8 Synthesis of N⁴-[(Dipropylamino)methylene]arabinocytidine(VIII)

Ara-C (85 mg, 0.35 mmol) in DMF (2 mL) was reacted withdipropylformamide dimethyl acetal (0.9 g, 5.14 mmol). Evaporation andcrystallization from ethanol-ethyl acetate gaveN⁴-[(Dipropylamino)methylene]arabinocytidine (104 mg, 85%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 9 Synthesis of N⁴-[(Dibutylamino)methylene]arabinocytidine (IX)

Ara-C (85 mg, 0.35 mmol) in DMF (2 mL) is reacted with dibutylformamidedimethyl acetal (0.9 g, 5.14 mmol). Evaporation and crystallization fromethanol-ethyl acetate gave N⁴-[(Dibutylamino)methylene]arabinocytidine(104 mg, 85%).

Example 10 Synthesis of N⁴-[(Diisopropylamino)methylene]arabinocytidine(X)

Ara-C (500 mg, 2.05 mmol) in DMF (10 mL) was reacted withdiisopropylformamide dimethyl acetal (2.3 g, 13.2 mmol). Afterevaporation, the residue was crystallized from ethanol-ether to givepale lemon-colored crystals ofN⁴-[(Diisopropylamino)methylene]arabinocytidine (723 mg, 93%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 11 Synthesis of N⁴-[Piperidinomethylene]arabinocytidine (XI)

Ara-C (500 mg, 2.05 mmol) in DMF (10 mL) was reacted with N-(dimethoxymethyl)piperidine (2.7 g, 16.8 mmol) for several hours at roomtemperature. The contents were evaporated and the residuechromoatographed over silica gel using 1-6% MeOH in CH₂Cl₂. The desiredfractions were collected and evaporated. The foam obtained wasrecrystallized from a mixture of ethanol, CH₂Cl₂, and ethyl acetate togive N⁴-[Piperidinomethylene]arabinocytidine (594 mg, 85%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 12 Synthesis of N⁴-[Morpholinomethylene]arabinocytidine (XII)

Ara-C (100 mg, 0.41 mmol) in DMF (5 mL) was reacted withN-(dimethoxymethyl)morpholine (1.35 g, 9.3 mmol). Evaporation andsubsequent crystallization from ethyl acetate-ether gaveN⁴-[Morpholinomethylene]arabinocytidine (130 mg, 93%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 13 Synthesis of N⁴-[Pyrrolidinomethylene]arabinocytidine (XIII)

Ara-C (100 mg, 0.41 mmol) in DMF (5 mL) was reacted withN-(dimethoxymethyl)pyrrolidine (0.9 g, 6.2 mmol). Evaporation andsubsequent crystallization from ethyl acetate-ether gaveN⁴-[Pyrrolidinomethylene]arabinocytidine (119 mg, 89%).

This procedure is taken from Kerr et al., J. Pharm. Sci. 83(4): 582-586(1994).

Example 14 Synthesis of N⁴-[Dimethylpiperidinomethylene]arabinocytidine(XIV)

Ara-C (500 mg, 2.05 mmol) in DMF (10 mL) is reacted with N-(dimethoxymethyl)dimethyl piperidine (2.7 g, 16.8 mmol) for several hours at roomtemperature. The contents are evaporated and the residue chromatographedover silica gel using 1-6% MeOH in CH₂Cl₂. The desired fractions arecollected and evaporated. The foam obtained is recrystallized from amixture of ethanol, CH₂Cl₂, and ethyl acetate to giveN⁴-[Dimethylpiperidinomethylene]arabinocytidine.

Example 15 Dose Response and Cell Toxicity Assay

This example demonstrates the ability of various compounds of theinvention to inhibit the ability of cells to maintain and replicate areplicon. The example also evaluates the toxicity level of the variouscompounds on the cells.

Cell Culture. Cells of the luciferase replicon cell line (Vrolijk etal., J. Virol. Methods 110:201-209 (2003)) was grown in Dulbecco'sminimal essential medium (DMEM) supplemented with 2 mM glutamine,non-essential amino acids (NEAA), 10 mM HEPES, 0.075% sodiumbicarbonate, 100 U/ml penicillin and 100 μg/mL streptomycin, and 10%fetal bovine serum. To maintain the selection for replicon, 0.3 mg/mL ofG418 were added to the culture media.

Dose-Response and Luciferase Assays. Replicon cells were seeded at 5000cells/well in 96-well collagen 1-coated Biocoat plates (BectonDickinson; Palo Alto, Calif.). Twenty-four hrs post-seeding, compounds(see Table 1 below) were added to replicon cells. The finalconcentration of DMSO was 0.5%, fetal bovine serum was 10%, and G418 wasnot added. The cells were incubated with the compounds for 2 days, atwhich point the cells were washed with PBS and lysed in 40 μl Glo LysisBuffer (Promega; Madison, Wis.). 20 μl of lysates were mixed with 100 μlLuciferase Assay Reagent (Promega) and read on a Microtiter PlateLuminometer MLX (DYNEX Technologies; Chantilly, Va.). The fold ofreduction in luciferase signal compared to no compound control wasplotted against drug concentration and fitted to the sigmoid doseresponse model using PRISM software (Graphpad Software Inc.; San Diego,Calif.).

Taqman Assay Method. Replicon cells were seeded at 4000 cells/well in96-well collagen 1-coated Biocoat Plates (Becton Dickinson). Twenty-fourhours post-seeding, compounds were added to replicon cells. The finalconcentration of DMSO was 0.5%, fetal bovine serum was 10%, and no G418was added. Cells were incubated with compounds for 2 days, at whichpoint the cells were washed with PBS and lysed in 1× cell lysis buffer(Ambion). The replicon RNA level was measured using real time PCR(Taqman assay). The amplicon was located in NS5B. The PCR primers were5B.2F, ATGGACAGGCGCCCTGA; 5B.2R, TTGATGGGCAGCTTGGTTTC; the probesequence was FAM-labeled CACGCCATGCGCTGCGG. GADPH RNA was used as anendogenous control and was amplified in the same reaction as NS5B(multiplex PCR) using primers and VIC-labeled probe recommended by themanufacturer (PE Applied Biosystem). The real-time RT-PCR reactions wererun on the ABI PRISM 7900HT Sequence Detection System using thefollowing program: 48° C. for 30 minutes, 95° C. for 10 minutes, 40cycles of 95° C. for 15 seconds, 60° C. for 1 minute. The ACT values(CT5B-CTGADPH) were plotted against drug concentration and fitted to thesigmoid dose response model using SAS system (SAS Institute, Inc.) orPRISM software (Graphpad Software, Inc.). IC50 was the drug doseresponse necessary to achieve an increase of 1 in ΔCT over the projectedbaseline. IC90 was the drug dose response necessary to achieve anincrease of 3.2 over the baseline. All Taqman reagents were from PEApplied Biosystem.

Cell toxicity assay. The toxicity of compounds on the replicon cellswere measured by MTS assay following manufacturer's instructions(Promega). Briefly, 20 μl of CellTiter 96®RAQueous One Solution Reagentwere added to each well of the 96-well plate containing 100 μl ofculture medium. The plates were incubated for 30-60 minutes beforereading OD by DYNEX MRX.

TABLE 4 Dose response and cell-toxicity assay results. Compound IC50(μM) IC90 EC50 EC90 CC50 TI X >10 >10 0.03 2 >10 >300 XI >10 >10 0.078 >10 >100 XII >10 >10 0.02 1.5 >10 >500 XIII >10 >10 0.09 5 >10 >100Cytarabine ~10 >10 0.05 4 >10 >200 Ribavirin 40-100 not reached 20 80~500 ~25IC50: drug dose necessary to reach a 2-fold decrease in replicon RNAlevel.IC90: drug dose necessary to reach a 10-fold decrease in replicon RNAlevelEC50: drug dose necessary to reach a 2-fold decrease in luciferasesignal.EC90: drug dose necessary to reach a 10-fold reduction in luciferasesignal.CC50: drug dose necessary to reduce the MTS signal to 50% of that of nodrug controlTI: CC50/EC50 in 5-2 cells.All units are μM.

The present invention is not to be limited in scope by the specificembodiments described herein. Indeed, various modifications of theinvention in addition to those described herein will become apparent tothose skilled in the art from the foregoing description. Suchmodifications are intended to fall within the scope of the appendedclaims.

Patents, patent applications, publications, product descriptions, andprotocols are cited throughout this application, the disclosures ofwhich are incorporated herein by reference in their entireties for allpurposes.

1. A method for treating an infection by a virus which is a member ofthe Flaviviridae family of viruses, in a mammalian host, comprisingadministering to said host a therapeutically effective amount of acompound represented by structural formula IV

or a pharmaceutically acceptable salt thereof or a pharmaceuticalcomposition thereof which composition comprises a pharmaceuticallyacceptable carrier; wherein R³ and R⁴ are independently —OH or apharmaceutically acceptable leaving group, wherein R⁵ is —OH, a straightor branched chain C₉ to C₂₄ alkylphosphate or a straight or branchedchain C₉ to C₂₄ alkenylphosphate group or a pharmaceutically acceptableleaving group and wherein R¹ and R² are independently C₁ to C₁₀ alkyl orwherein R¹ and R² taken together with N form a C₃ to C₇ ring representedby the following structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

and wherein said pharmaceutically acceptable leaving groups are capableof being converted to —OH, -phosphate, —F or —CH₃ when the compound ofstructural formula IV is administered in vivo and are independentlyrepresented by structural formula

wherein Y═H, CH₃, CH₃CH₂—, CH₃CH₂CH₂—, Me₂CH—, Me₂CH₂CH₂—,CH₃CH₂CH(Me)-, PhCH₂—, HOOCCH₂CH₂—, HSCH₂—, HOOCCH₂—, MeSCH₂CH₂—,HOCH₂—,

H₂N(CH₂)₄—, or CH₃CH(OH)—, or a pharmaceutically acceptable saltthereof, or Y, taken together with the alpha-carbon and N, form

wherein the pharmaceutically acceptable leaving groups are capable ofbeing converted to —OH, -phosphate, —F or —CH₃ when the compound ofstructural formula IV is administered in vivo and are independentlyrepresented by a structural formula selected from the group consistingof:

in association with one or more further chemotherapeutic agents.
 2. Themethod of claim 1 wherein the further chemotherapeutic agent is: aribonucleoside analogue, an IMPDH inhibitor, an N-glycosylationinhibitor, an N3 protease inhibitor, an NS5B inhibitor, animmunomodulatory compound, a CTP synthase inhibitor, a thiazolidinederivative, a benzanilide, a phenanthrenequinone, a helicase inhibitor,a polymerase inhibitor, an antisense phosphothioateoligodeoxynucleotide, an IRES-dependent translation inhibitor, anuclease resistant ribozyme, a 1-amino-alkyloyclohexane, an alkyl lipid,an antioxidant, squalene, amantadine, a bile acid,N-(phosphonoacetyl)-L-aspartic acid, a benzenedicarboxamide, apolyadenylic acid, 2′,3′ dideoxyinosine, or a benzimidazole.
 3. Themethod of claim 1 wherein the further chemotherapeutic agent is one ormore members selected from the group consisting of: gemcitabine, VX497,mycophenolate mofetil, EICAR, tiazofurin, deoxynojirimycin,N-nonyl-deoxynojirimycin, n-butyl deoxynojirimycin, albumin-interferonalpha, BILN-2061, thymalfasin, isatoribine, NM283, NM107,

gliotoxin, RD3-4082, RD3-4078,

RD4-6205, cerulenin, ceplene, amantadine, IDN-6556, naphthoquinone,2-methylnaphthoquinone, 2-hydroxynaphthoquinone,5-hydroxynaphthoquinone, 5,8-dihydroxynaphthoquinone, alkannin, orshikonin, 1-amino-1,3,5-trimethylcyclohexane;1-amino-1(trans),3(trans),5-trimethylcyclohexane;1-amino-1(cis),3(cis),5-trimethylcyclohexane;1-amino-1,3,3,5-tetramethylcyclohexane;1-amino-1,3,3,5,5-pentamethylcyclohexane;1-amino-1,3,5,5-tetramethyl-3-ethylcyclohexane;1-amino-1,5,5-trimethyl-3,3-diethylcyclohexane;1-amino-1,5,5-trimethyl-cis-3-ethylcyclohexane;1-amino-(1S,5S)cis-3-ethyl-1,5,5-trimethylcyclohexane;1-amino-1,5,5-trimethyl-trans-3-ethylcyclohexane;1-amino-(1R,5S)trans-3-ethyl-1,5,5-trimethylcyclohexane;1-amino-1-ethyl-3,3,5,5-tetramethylcyclohexane;1-amino-1-propyl-3,3,5,5-tetramethylcyclohexane;N-methyl-1-amino-1,3,3,5,5-pentamethylcyclohexane;N-ethyl-1-amino-1,3,3,5,5-pentamethylcyclohexane;N-(1,3,3,5,5-pentamethylcyclohexyl)pyrrolidine, d-α-tocopherol,tauroursodeoxycholic acid, chenodeoxycholic acid, ursodeoxycholic acid,free bile acid; 1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-trans-(4,5,6,7,8,9-hexahydro)benzimidazoyl)piperidine;1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-benzimidazoyl)piperidine;N,N′-4-[(2-benzimidazole)phenyl]-1,4-butanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,6-hexanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,8-octanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,9-nonanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,10-decanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,4-butenedicarboxamide;2′,3′-dideoxyinosine,

VX-950, viramidine and levovirin.
 4. The method of claim 1 wherein thehost is administered the compound represented by structural formula IVfollowing transplantation of a liver into said host or transfusion ofblood into said host.
 5. The method of claim 1 wherein the compound isrepresented by a structural formula selected from the group consistingof:


6. A composition represented by structural formula IV

or a pharmaceutically acceptable salt thereof or a pharmaceuticalcomposition thereof which composition comprises a pharmaceuticallyacceptable carrier; wherein R³ and R⁴ are independently —OH or apharmaceutically acceptable leaving group, wherein R⁵ is a straight orbranched chain C₉ to C₂₄ alkylphosphate or a straight or branched chainC₉ to C₂₄ alkenylphosphate group and wherein R¹ and R² are independentlyC₁ to C₁₀ alkyl or wherein R¹ and R² taken together with N form a C₃ toC₇ ring represented by the following structural formula:

wherein n and m are independently 0, 1, 2 or 3 and Q is CH₂, NR, O, S,SO or SO₂; and R is independently H, C₁ to C₆ alkyl or C₁ to C₆ acyl orwherein R¹ and R², taken together with the N, are represented by thestructural formula:

and wherein said pharmaceutically acceptable leaving groups are capableof being converted to —OH, -phosphate, —F or —CH₃ when the compound ofstructural formula IV is administered in vivo and are independentlyrepresented by the structural formula

wherein Y═H, CH₃, CH₃CH₂—, CH₃CH₂CH₂—, Me₂CH—, Me₂CH₂CH₂—, CH₃CH₂CH(Me)-, PhCH₂—, HOOCCH₂CH₂—, HSCH₂—, HOOCCH₂—, MeSCH₂CH₂—, HOCH₂—,

H₂N(CH₂)₄—, or CH₃CH(OH)—, or a pharmaceutically acceptable saltthereof, or Y, taken together with the alpha-carbon and N, form

wherein said pharmaceutically acceptable leaving groups are capable ofbeing converted to —OH, -phosphate, —F or —CH₃ when the compound ofstructural formula IV is administered in vivo and are independentlyrepresented by a structural formula

selected from the group consisting of: in association with one or morefurther chemotherapeutic agents.
 7. A composition which is representedby a structural formula selected from the group consisting of:

in association with one or more further chemotherapeutic agents.
 8. Thecomposition of claim 6 wherein the further chemotherapeutic agent is: aribonucleoside analogue, an IMPDH inhibitor, an N-glycosylationinhibitor, an N3 protease inhibitor, an NS5B inhibitor, animmunomodulatory compound, a CTP synthase inhibitor, athiazolidinederivative, a benzanilide, a phenanthrenequinone, a helicase inhibitor,a polymerase inhibitor, an antisense phosphothioateoligodeoxynucleotide, an IRES-dependent translation inhibitor, Anuclease resistant ribozyme, a 1-amino-alkyloyclohexane, an alkyl lipid,antioxidants, squalene, amantadine, a bile acid,N-(phosphonoacetyl)-L-aspartic acid, a benzenedicarboxamide, apolyadenylic acid derivative, 2′,3′ dideoxyinosine, or a benzimidazole.9. The composition of claim 6 wherein the further chemotherapeutic agentis one or more members selected from the group consisting of:gemcitabine, VX497, mycophenolate mofetil, EICAR, tiazofurin,deoxynojirimycin, N-nonyl-deoxynojirimycin, n-butyl deoxynojirimycin,albumin-interferon alpha, BILN-2061, thymalfasin, isatoribine, NM283,NM107,

gliotoxin, RD3-4082, RD3-4078,

RD4-6205, cerulenin, ceplene, amantadine, IDN-6556, naphthoquinone,2-methylnaphthoquinone, 2-hydroxynaphthoquinone,5-hydroxynaphthoquinone, 5,8-dihydroxynaphthoquinone, alkannin, orshikonin, 1-amino-1,3,5-trimethylcyclohexane;1-amino-1(trans),3(trans),5-trimethylcyclohexane;1-amino-1(cis),3(cis),5-trimethylcyclohexane;1-amino-1,3,3,5-tetramethylcyclohexane;1-amino-1,3,3,5,5-pentamethylcyclohexane;1-amino-1,3,5,5-tetramethyl-3-ethylcyclohexane;1-amino-1,5,5-trimethyl-3,3-diethylcyclohexane;1-amino-1,5,5-trimethyl-cis-3-ethylcyclohexane;1-amino-(1S,5S)cis-3-ethyl-1,5,5-trimethylcyclohexane;1-amino-1,5,5-trimethyl-trans-3-ethylcyclohexane;1-amino-(1R,5S)trans-3-ethyl-1,5,5-trimethylcyclohexane;1-amino-1-ethyl-3,3,5,5-tetramethylcyclohexane;1-amino-1-propyl-3,3,5,5-tetramethylcyclohexane;N-methyl-1-amino-1,3,3,5,5-pentamethylcyclohexane;N-ethyl-1-amino-1,3,3,5,5-pentamethylcyclohexane;N-(1,3,3,5,5-pentamethylcyclohexyl)pyrrolidine, d-α-tocopherol,tauroursodeoxycholic acid, chenodeoxycholic acid, ursodeoxycholic acid,free bile acid; 1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-trans-(4,5,6,7,8,9-hexahydro)benzimidazoyl)piperidine;1,1′-[1,4-phenylenebis(methylene)]bis(4,4′-benzimidazoyl)piperidine;N,N′-[(2-benzimidazole)phenyl]-1,4-butanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,6-hexanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,8-octanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,9-nonanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,10-decanedicarboxamide;N,N′-4-[(2-benzimidazole)phenyl]-1,4-butenedicarboxamide;2′,3′-dideoxyinosine,

VX-950, viramidine and levovirin.
 10. The composition of claim 6 whereinthe further chemotherapeutic agent is one or more members selected fromthe group consisting of: ribavirin, interferon alfa-2a, interferonalfa-2b, PEGylated Interferon alfa-2a, and PEGylated Interferon alfa-2b.11. The composition of claim 7 wherein the further chemotherapeuticagent is one or more members selected from the group consisting of:ribavirin, interferon alfa-2a, interferon alfa-2b, PEGylated Interferonalfa-2a, and PEGylated Interferon alfa-2b.